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Treatment for high grade non Hodgkin lymphoma

Treatment for high grade lymphoma depends on how many lymph nodes are affected by lymphoma and their position in the body. It also depends on the type of lymphoma, the symptoms you have at the time, and your general health and fitness.

Limited high grade NHL means that you have lymphoma in only one or two groups of lymph nodes on the same side of the diaphragm. The diaphragm is a sheet of muscle just under the lungs. In this case, you may have a short course of chemotherapy and a biological therapy drug, followed by radiotherapy to the affected lymph nodes. Or you may have a longer course of chemotherapy and a biological therapy without radiotherapy. Whether you have radiotherapy depends on different factors such as where the lymphoma is and how fit you are.

Advanced high grade NHL means that the lymphoma is in more than one area of the body, or a lymph gland measures more than 10cm, or you have night sweats, temperatures or weight loss. You will probably have chemotherapy treatment with 3 or 4 different drugs, or more, and a biological therapy. The exact choice of treatment depends on which type of high grade NHL you have.

Diffuse large B cell lymphoma

Diffuse large B cell lymphoma (DLBCL) is the most common type of high grade NHL. For this type of lymphoma you usually have CHOP chemotherapy together with the biological therapy rituximab. This treatment is called R-CHOP.

Treatment to prevent NHL spreading to the brain

For some types of NHL, you may have chemotherapy into the fluid around your spinal cord. This treatment aims to prevent lymphoma cells from spreading to the brain. Usually, you have a drug called methotrexate. Sometimes high dose methotrexate injections are given into the bloodstream, instead of into the fluid around the spinal cord.

Treatment for limited high grade NHL

In high grade lymphoma, limited disease means stage 1A. The lymphoma is in only one group of lymph nodes and you don't have symptoms such as night sweats, temperatures or weight loss (B symptoms). You may have a short course of chemotherapy and a biological therapy drug, followed by radiotherapy to the affected lymph nodes. A short course of chemotherapy usually takes about 6 to 12 weeks.

Or you may have a longer course of chemotherapy and a biological therapy drug without radiotherapy. Whether you have radiotherapy will depend on different factors, such as where the lymphoma is in the body and how fit you are.

For the most common type of high grade NHL, diffuse large B cell lymphoma (DLBCL), you are most likely to have CHOP chemotherapy. You have it with a biological therapy drug called rituximab. This treatment is known as R-CHOP.

Treatment for advanced high grade NHL

Advanced high grade NHL means that the lymphoma is in more than one area of the body, or a lymph gland measures more than 10cm, or you have night sweats, temperatures or weight loss.

In practice, most people with high grade NHL are treated as if it were advanced disease. This means quite intensive chemotherapy treatment, with 3 or 4 different drugs, or more, usually over 6 to 8 months. You have some or all of these drugs through a drip into a vein. Or you may have a tube put into a vein in your chest, such as a central line or a portacath. Or you may have a PICC line into a vein in your arm. These tubes stay in throughout your treatment.

The exact choice of treatment depends on which type of high grade NHL you have. Most of the chemotherapy combinations contain a drug called doxorubicin. This type of chemotherapy works well for many types of high grade NHL.

Treatment to prevent spread to the brain

If the lymphoma is affecting the space behind your nose (the paranasal sinuses)

If the lymphoma is affecting your testicles.

This is because there is a chance of lymphoma cells spreading to the brain in these situations. The treatment is to prevent that happening. You may hear this called prophylactic treatment. Usually, you have a drug called methotrexate.

Some doctors prefer to use radiotherapy to the brain instead of chemotherapy into the spine. Or you may have high dose methotrexate injections into the bloodstream, instead of into the fluid around the spinal cord. This is similar to having a lumbar puncture.

Bone marrow or stem cell transplants

Intensive chemotherapy increases the risk of complications like infection, but gives the best chance of curing the lymphoma. Some people with faster growing types of high grade non Hodgkin lymphoma have very intensive high dose chemotherapy. This treatment is followed with a bone marrow or stem cell transplant. Faster growing lymphomas tend to come back fairly soon after you get into remission.

It is not easy for doctors to decide who will do best with high dose chemotherapy treatment. There are no hard and fast rules. You have to be fit enough to make a good recovery from the treatment. And you are probably more likely to be offered this type of treatment if

Your lymphoma has come back after other treatments

You have a type of NHL that is faster growing and likely to come back quickly after standard chemotherapy

You have lots of affected lymph nodes

The NHL is in your bone marrow or other body organs as well as in the lymph nodes

More about NHL

If you would like more information about any aspect of non Hodgkin lymphoma, you can phone the Cancer Research UK nurses on freephone 0808 800 4040. The lines are open from 9am to 5pm, Monday to Friday. They will be happy to answer any questions that you have.

Our non Hodgkin lymphoma organisations page gives details of other people who can provide information about NHL and its treatment. Some organisations can put you in touch with a cancer support group. They often have free factsheets and information which they can send to you.

There are also books, booklets, CDs and other resources available about non Hodgkin lymphoma. Some of these are free. Look at our NHL reading list for details.

If you want to find people to share experiences with online, you could use Cancer Chat, our online forum.

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